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Medical Justice

Making healthcare safe for doctors


Healthcare Reform

Is Pimping Really Abusive?

01/08/16 4:42 PM

Yesterday, I read two articles in JAMA on pimping. (Yes, I still get JAMA.) The article suggested that pimping medical students and residents may be “old school.” Used inappropriately, it may serve more as a tool off abuse and humiliation as opposed to a pedagogical art.

Duh.

Anything used inappropriately can be viewed as abusive or, well…er, inappropriate.

That includes language, relationships, guns, medications….The list is long.

First, to those reading this who believe I am talking about business oversight of prostitutes. Nope. In medicine, pimping is the art of asking those junior to you rapid-fire medical questions. About your patient. About patient care. About medical trivia. About ontogeny recapitulating phylogeny.

It’s a rite of passage. And it is often stressful.

For those teachers who are using it the right way, they hope their students will “come to class” prepared. Most teachers want curious students to learn and succeed. It’s actually less time consuming to just pass the below-average medical student and make him/her someone else’s problem down the road. Pimping is labor intensive for both the pimper and the pimpee. The pimper has to remember the Krebs cycle and brachial plexus anatomy to stump the pimpee.

Socrates used the same techniques.

Next, pimping gets the student used to stress. Practicing medicine is stressful. Taking care of patients is not easy. Why pretend otherwise? Keeping medical students and residents in a cocoon will only delay that day of reckoning. If doctors are to perform, they need to be tested. This is no different for military personnel, police officers, and professional athletes.

Does pimping have other less beneficial purposes? Of course. When I took my oral neurosurgical boards, each session had two examiners. In one session, one of my examiners had been in practice for decades. He was seasoned with gray hair. He believed his job was to ensure I would represent the field honorably. He wanted to make sure my judgment was sound and that I would not hurt any patients.

The other examiner was green. He had graduated from his neurosurgical residency a few years earlier. He was junior faculty at an academic institution. And, he was working his way up the food chain. The questions he asked were nothing like those of his more senior colleague.

I was being pimped.

I got the impression his questions had more to do with impressing his senior colleague, than actually testing me.

Still, I passed.

A rite of passage.

If a pimper is focused solely on humiliation and abuse and has no interest in pedagogy, then, that person has no place in teaching. But, most pimpers believe a greater goal is being served.

My vote: Let the pimping continue. What do you think?

Posted by Medical Justice | in Healthcare Reform | 23 Comments »
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Mehraboon Irani
Guest
Mehraboon Irani

Yes, I agree

E F Livingstone
Guest
E F Livingstone

Pimping to challenge and stimulate for educational purposes is an important aspect of the medical education of physicians.

SAS
Guest
SAS

Yes, from personal experience I can say it is abusive.

A good teacher teaches. Firing away questions is something any idiot can do.

Brian Holmes, MD
Guest
Brian Holmes, MD

I was so much more capable of thinking on my feet and defining preparedness at the end of my third-year medical school rotations than I was at the beginning. Pimping was essential. I can recall specific facts from those encounters to this day–28 years later. I had the privilege of completing a neurosurgery residency under the training of true gentlemen who never abused their authority over me, but pimped and maintained very high expectations. Work hour restrictions have diluted residency training too much as it is. If we eliminate pimping, turning medical education into a “safe zone,” graduates will become… Read more »

Joe Horton MD
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Joe Horton MD

Depends. If it actually furthers someone’s education and/or ability to stand up to stress, fine. If it’s just to make the pimper feel superior to the pimpee, it’s bullshit. Here’s a non-medical example: friend of mine, another retired surgeon, was with a flight instructor. Chuck was concentrating on flying, the instructor on being irritating–kept asking him trivial questions that had nothing to do with what was going on in the cockpit at the time. Chuck became increasingly annoyed until he decided to do something. As he was flying, he kept trimming the plane nose up until he couldn’t any more.… Read more »

George Vito
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George Vito

If you think pimping in the medical profession is abusive, try a law school class, here my friends lye the true pimping artists….

George R. Vito, DPM, MBA, JD

Lee
Guest
Lee

In surgical residencies this was done to humiliate the intern or junior resident. There was no teaching involved. Expecting people to know that which they could not possibly know without direction or some head’s up ahead of time is humiliation. Due to psychology the humiliation aspects are remembered long after the medical information looked up after the incident is forgotten. Ex as a very young surgical intern I was second assisting a very senior surgeon, author of several surgical textbooks, and former head of an illustrious surgical training program in NYC. (One of these texts was given to me years… Read more »

steven teitelbaum
Guest
steven teitelbaum

I loved being pimped because I could show I knew more than the other residents. I would feel bad for the others getting humiliated. But how much sympathy should i have had for a resident who did a case but didn’t read up on it? The fear of rounds drove me to find a moment to read up on all my patients. As self-motivated as i am, there is no doubt that the pressure of looking smart on rounds drove me to read more and more intensely. And it puts you in your proper place. Here’s an example: on my… Read more »

William Burden
Guest
William Burden

I love pimping! I use it to teach my children, new employees, and medical personnel every day. I regularly get positive feedback from all involved. I live being pimped! I prepare for every thing I do. If I can’t answer correctly, I appreciate the lesson and/or look it up. In my opinion, if you can not take pimping, you shouldn’t be in medicine or any other profession. If you can answer the attending’s pimping, the student has learned and the teacher has taught. Abusive professors are just that. We all know who they are/were. I don’t respect them and will… Read more »

Michael F. Mascia, MD, MPH
Guest

Great blog, Doc. Yes, let pimping continue for the sake of the patients we are here to serve. I can tell by the responses that some of the folks are a bit soft. Mother Nature (disease and critical illness) does not cater to our wishes, folly or politically correct ideas about how things should be. I Love the profession of medicine and the great works of Medical art that can be done by master physicians. And, I will teach anyone and everyone what I know in accordance with the Hippocratic Oath. But, the expectation is that each “student” will pledge… Read more »

Cole Goodman
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Cole Goodman

I am in complete agreement with Drs Teitelbaum, Burden, and Mascia.
If you aren’t prepared for a little pimping, you most likely are not prepared to treat the patients.

Lars Enevoldsen,MD
Guest
Lars Enevoldsen,MD

Looking back at med school and residency, I would divide “pimpers” into two categories. In the first group were those who might make me miserable but taught me much because they were good at what they did, knew their stuff, and were ultimately able to convey useful knowledge. In the other group were those who were quite the opposite. Claude Organ, “The Malignant Melanoma”, comes to mind. Couldn’t cut their way out of a wet paper bag, thought they knew far more than they actually did and were often dead wrong. Their only purpose seemed to be to abuse and… Read more »

Anon
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Anon

In the “old days”, we prepared thoroughly for rounds with our chairman. If you survived the pimping, you looked like a stud in the eyes of all. If you didn’t know an answer, you remained silent and the hot potato would be tossed. This was not used to embarrass – just to make you better and smarter.

Pimping is probably dead. Residents today are weak, apathetic, and scared, with hundreds of thousands of dollars of debt, and a bleak future looking forward.

Ed Lewis
Guest
Ed Lewis

I was pimped. As a result of this and other teaching techniques, I worked/studied harder. It was at times humiliating, at times exciting. I was haized, especially in residency, with other cruel techniques, but only by a few attendings we all tried to avoid. Others were great! My experience trained me well to be a very good doctor…I got over the stress, only to have it replaced with that of a lifetime career in private practice, and I love what I do. In the end, medicine is not for everyone.

Jackson Thatcher MD
Guest
Jackson Thatcher MD

Pimping. V/N. To ask a question fully knowing the answer in advance. i.e. the Socratic method of learning in which the teacher poses a question of the students, in fact offering the lesser in the relationship: Teacher vs. Student, to take on the role of Teacher who then is judged by their own peers on the content of their thoughts and the merits of their work. It seemed to work well for Socrates, until some former students tiring of his failure to realize they had already graduated to running Athens, and they invited him out for a drink. As long… Read more »

Josh Grossman, Colonel MC MD FACP
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Josh Grossman, Colonel MC MD FACP

Outstanding!
Ideal for U.S.M.L.E. Step III!
Ideal for A.B.I.M. Certification!
Humble thanks!

Michael M. Rosenblatt, DPM
Guest
Michael M. Rosenblatt, DPM

When I was a resident going through an anesthesiology rotation, the chief asked me to calculate a CO2 concentration, given certain parameters. I didn’t have a pencil or paper, but SOMEHOW got the right answer. I have no idea where it came from. He told me that I was one of the only residents who ever got it right. I was stunned. I also reviewed the math immediately just in case he might ask me again. He never did. I was also a residency co-director in my career and responsible for teaching residents. I would ask them questions. This was… Read more »

SMP
Guest
SMP

I think that you need to define “pimping” better. Is it rapid-fire questions until the resident turns blue and drops? Is it inane questions that no one knows the answer to that makes the questioner look really smart? I like to ask questions on rounds to show the interns and residents how to think about a patient and their management. My pet peeve from the time that I was a medical student is the “numbers question”…i.e. “What percentage of x people get Y disease if they have Z symptom?” etc etc. One morning a cardiology attending was going around asking… Read more »

SMP
Guest
SMP

disclaimer: Yes, I am a female physician and I have been around for decades so I don’t offend easily….

Filliberto Rodriguez, MD, FACS
Guest

I agree completely with Dr. Holmes above. Pimping is fine. What I noticed in my training and even now in my practice, is that prepared and capable (i.e. “Strong”) students do not mind being pimped by a good professor (not abusive). It is the unprepared (i.e. “weak”) students who whine and complain about how unfair, or demoralizing, pimping feels.

Marvin Borsand, D.O.,FACOS,FAACS
Guest

I was fortunate in that I worked long hours and not confined to only 8 hours per day. That caring for and being able to be apart of the patients entire stay gas me the hands on experience that is the best way for me to learn. I didn’t have any real pimp trainers so hard for e to comment on its effectiveness. In my fellowship I don’t pimp since most of the fellows are sharper didactically then me though I do have them on the clinical experience side.

Steven Bornfeld, DDS
Guest

I’m surprised no one has objected to the term, nor thought about how this term (in common usage involving exploitation by a male of usually younger, more-or-less powerful females) in a conservative, historically male-dominated profession. I think that probably a less emotionally-charged term might be found. As for the “pimping” itself, judging it goes to intent. Clearly it is used as motivation to be prepared. Clearly also it is used to humiliate, for whatever reasons the party might have. A long-dead professor of mine who was quite openly sexist and racist with hundreds of witnesses present–there was no question. That… Read more »

Doctor of Democracy
Guest
Doctor of Democracy

It has been well covered here that the fear of pimping gave incentive to many of us to study and prepare harder, to the benefit of ourselves and our patients. By the way, I was comfortable enough in my own skin to say “I don’t know” without becoming suicidal over it. If it was a rare, zebra, esoteric question, I didn’t beat myself up over a best estimate, and stating that it was a best estimate. The main question seems to be about the malignant, “abusive” attendings. I would suggest that these were just as useful. Fear of my residency’s… Read more »